Musicians are often told “practice makes perfect”, but the strain of playing for many hours a day can lead to constant pain – and even the end of a career.

What exactly is RSI?

Since the introduction of computer keyboards in workplaces, RSI (Repetitive Strain Injury) and carpal tunnel syndrome have entered our vocabulary, but musicians have been dealing with these debilitating disorders for generations. RSI is a general term for disorders that develop from repetitious activity of the hands; carpal tunnel syndrome is its most common form amongst professional musicians.

The gruelling hours of practice necessary to forge their careers pushes the fine motor skills of their hands and wrists to the limit. As a result, many musicians play in a constant state of pain or disability – ranging from burning, swelling and tingling, to numbness and loss of dexterity. In the most serious cases, they are forced to end their careers prematurely.

What factors contribute to RSI in musicians?

Many controversies exist over whether RSI is caused by playing with the wrong technique or simply overuse. It is no wonder pianists and string players are the worst affected when you consider that a professional violinist will move the bow back and forth through its full range of motion thousands of times a day, and a pianist may practice fast passages for eight hours daily.

These activities put tremendous strain on the small muscles of the hand and are made worse by factors such as bad posture and playing with tense muscles, often caused by nervousness, stress or physical exhaustion.

So just how common is it?

It’s a lot more common than you’d think. An astounding 50 to 60 per cent of orchestra players have suffered from RSI in their arms and/or hands, causing significant pain or disability, from playing their instruments at some point. RSI can also be dream-shattering for the 20 per cent of students who will suffer from it. Even with statistics this high, it is thought many cases go unreported.

The stigma surrounding injuries and the fear of losing career opportunities means that many ignore the signs and resist treatment. One such example is well-known American pianist Gary Graffman, who concealed and denied his injury for years before seeking treatment.

Historically, has RSI always been an obstacle for musicians?

Performance-related injuries increased during the 19th century due to changes in piano construction. The new pianos had heavier keys and stronger frames, creating more resistance for the fingers. In addition, composers such as Chopin and Liszt began writing pieces that required greater physical endurance and technical brilliance from the performer.

Have many famous pianists suffered from RSI?

American pianist Leon Fleisher’s injury kept him from playing for 15 years. Meanwhile, when friend Gary Graffman eventually sought treatment for his right hand in the 1970s, doctors could find no cause for the pain and numbness he claimed to suffer so he was diagnosed with having a neurological disorder. Graffman has since commissioned concertos for left hand from composers such as Ned Rorem.

Others whose careers were affected by RSI ­– forcing cancellations of concerts or repertoire restrictions – include Artur Schnabel, Sergei Rachmaninov, Glenn Gould and Richard Goode. Many famous conductors and composers were born out of performers whose RSI made it impossible for them to continue playing.

What treatments are available to musicians?

The simplest treatments are rest from playing, acupuncture and physical therapy. But in more serious cases, cortisone injections, overhaul of playing technique and surgery are necessary. The Alexander Technique and Feldenkrais Method focus on movement and posture to help musicians play with less tension and fatigue.

These methods can supplement the Taubman Approach, which focuses on proper alignment and forearm rotations that reduce the need to twist and stretch in awkward positions. The Taubman Approach – originally developed for pianists – has recently been translated to apply to string instruments as well.

What happened to Schumann’s hands?

Speculation surrounds the injury that Schumann sustained in his hands. While many now believethat it was a form of RSI, traditional belief was that it was the result of a finger-stretching mechanical device he used. Doctors who examined him concluded that it was all in his imagination, resulting from his “hypochondriacal” personality. Treatments for his condition included drinking alcohol (his own remedy), eating large quantities of raw meat, soaking his arm in brandy, and even inserting his arm in the carcasses of freshly slaughtered animals.